{"title":"Departments at Bombay Hospital Institute of Medical Sciences Neurology Department","authors":"S. Khadilkar","doi":"10.15713/ins.bhj.26","DOIUrl":"https://doi.org/10.15713/ins.bhj.26","url":null,"abstract":"","PeriodicalId":85654,"journal":{"name":"The Bombay Hospital journal","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80873380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Toxoplasmic Retinochoroidal Granuloma with Macular Pucker: A Case Report","authors":"Sailie Shirodkar, N. Shah","doi":"10.15713/ins.bhj.36","DOIUrl":"https://doi.org/10.15713/ins.bhj.36","url":null,"abstract":"A 19-year-old girl presented to our institute with gradual, progressive diminution of vision in the right eye for the past 4 months, accompanied by recurrent pain and redness. She reported no history suggestive of trauma, underlying systemic illnesses, recent changes in health, family history of eye disease, or history of such an episode. She was noted to have undergone several tapering courses of oral and topical steroids coupled with topical cycloplegics and broad-spectrum antibiotics at multiple facilities. On ophthalmic examination, the best-corrected visual acuity in the right eye was reduced to FC at 1 m. The conjunctiva was congested and she had a Grade V relative afferent pupillary defect. There were no cells or flare in the anterior chamber, and the rest of the ocular examination was within normal limits. The left eye was unremarkable. The systemic examination was normal. The ocular fundus examination revealed mild vitritis with a granulomatous epiretinal membrane (ERM) over the macula, approximately 7.5 mm × 2.5 mm in dimensions (extending 5 disc diameters temporal to the optic disc). Two focal lesions were also observed inferior to the disc [Figure 1a]. The contralateral fundus was normal. The patient underwent comprehensive infectious laboratory workup which revealed significantly raised anti-toxoplasma IgG antibody titer (13.2 IU/ml; reference level: <1.3 IU/ml), while other tests were found to be normal. Furthermore, ultrasound B-scan of the right eye showed vitreous echoes with marked macular thickening, the latter finding being confirmed on optical coherence tomography (OCT) [Figure 1b].The patient was, therefore, definitively treated as a case ocular toxoplasmosis. We started the patient on the classical triple therapy with oral corticosteroids (40 mg/day in tapering doses), pyrimethamine (50 mg daily for 4 weeks), and sulfasalazine (1 g daily for 4 weeks), as a result of which the peripheral lesions were found to resolve. Tablet folinic acid (5 mg thrice a week) was added to prevent bone marrow suppression secondary to chemotherapeutic agents. Complete blood count and platelet counts were done on a weekly basis to monitor potential side effects. Following commencement of the antibiotic regimen, there was minimal improvement in vision. Although the peripheral lesions were found to respond to treatment, the patient presented with a persistent granulomatous ERM over the macula even after the antibiotic regimen. This led to stagnation of the response to therapy. Vitrectomy with ABSTRACT","PeriodicalId":85654,"journal":{"name":"The Bombay Hospital journal","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87033018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Marathe, M. Malhotra, B. Yelikar, Toshi Mishra, S. Ramasamy, Prachi Tawde, G. Patil
{"title":"Correlation of FNAC to Histopathology in Skin Lesions of Leprosy as Per Ridley-Jopling Spectrum","authors":"P. Marathe, M. Malhotra, B. Yelikar, Toshi Mishra, S. Ramasamy, Prachi Tawde, G. Patil","doi":"10.15713/ins.bhj.02","DOIUrl":"https://doi.org/10.15713/ins.bhj.02","url":null,"abstract":"eprosy, also called Hansen's disease, Lis a chronic infectious disease that affects the peripheral nerves, skin, upper respiratory tract, eyes and nasal mucosa. It causes skin sores that are disfiguring, nerve damage and muscle weakness that gets worse over time. It was discovered by G.A. Hansen in Norway in 1873. There are 2 types of leprosy: tuberculoid leprosy and lepromatous leprosy. Tuberculoid leprosy is the less severe and less contagious. Lepromatous leprosy is the more severe and is more contagious. This type affects the organs such as kidneys, testicles, eyes and nose. Leprosy is difficult to study. Mycobacterium Leprae multiplies slowly and symptoms can take as long as 20 years to appear. Armadillos are the only animal other than humans that have been found to become naturally infected by this","PeriodicalId":85654,"journal":{"name":"The Bombay Hospital journal","volume":"290 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79456911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"COVID-19 in a Patient with Autoimmune Scleritis on Triple Immunosuppression – An Immunological Perspective","authors":"M. Moreker, A. Bansal","doi":"10.15713/ins.bhj.37","DOIUrl":"https://doi.org/10.15713/ins.bhj.37","url":null,"abstract":"Dear Editor, The ongoing COVID-19 pandemic can be vexing for uveitis specialists; especially when faced with a situation; wherein a follow-up patient on immunosuppressants; tests positive for SARS-CoV-2. It was indeed extremely worrisome for us; when our patient; a 41-year-old diabetic lady with autoimmune posterior scleritis with a follow-up of about 8 months; on 12.5 mg/day of oral prednisolone, weekly subcutaneous 25 mg methotrexate and 3 monthly 750 mg pulsed intravenous cyclophosphamide tested positive for SARS-CoV-2 after having an episode of fever and body ache for 5 days; in June 2020. Increased predisposition to infection because of our immunosuppressive treatment and possible worse outcome was our logical concerns. This led us to study the interaction of the human immune system with SARS-CoV-2 and the implications that such an interaction would have; in a patient on immunomodulatory treatment. Immune responses to SARS-CoV-2 include all arms of the immune system; tissue barriers, innate and adaptive cells, and mediators. The innate immune response is first activated mainly through pattern recognition receptors; resulting in release of Type 1 interferons and other inflammatory cytokines. In more severe infections, there is lymphopenia with reduced CD4+ T cells, CD8+ T cells, B cells, and natural killer cells and reduced monocytes, eosinophils, and basophils. The dreaded “cytokine storm” with excessive release of pro-inflammatory cytokines interleukin (IL)-6, IL-1β, IL-2, IL-8, IL-17, granulocyte colonystimulating factor, granulocyte macrophage colony-stimulating factor, interferon gamma-induced protein-10, monocyte chemoattractant protein-1, macrophage inflammatory protein1α, and tumor necrosis factor occurs in severe cases with resultant extensive tissue damage in lungs and other organs. Thus, an impaired initial adaptive immune response, followed by an uncontrolled activation of the innate immune response, causes severe disease.[1] An experimental coronavirus retinopathy model explains this biphasic nature of severe disease; a direct viral insult is at the basis of the initial infection which later on turns into a severe immune reaction, leading to potentially massive tissue damage.[2] Current best practice guidelines worldwide in relation to COVID-19 and immunosuppression in ophthalmology recommend the continuation of immunosuppressive treatment in patients who require them; with few exceptions.[3] The objective of continuation of immunosuppression is maintenance of remission on treatment, thus avoiding the need for possible high dose corticosteroid therapy in case of a relapse on an attempt to stop or taper these agents; which can be counterproductive.[3] In case of COVID-19 in a patient on these agents; data extrapolated from other specialties suggests reduction of oral prednisolone to <40 mg/day, temporarily withholding immunomodulatory treatments; while carefully monitoring COVID-19 disease and resumption of treatment once patient ","PeriodicalId":85654,"journal":{"name":"The Bombay Hospital journal","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88434780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Mansukhani, Alika Sharma, Lajita Balakrishnan, Priyanka Chavan
{"title":"Distal Myasthenia Gravis: A Missed Clinical Diagnosis","authors":"K. Mansukhani, Alika Sharma, Lajita Balakrishnan, Priyanka Chavan","doi":"10.15713/ins.bhj.35","DOIUrl":"https://doi.org/10.15713/ins.bhj.35","url":null,"abstract":"Myasthenia gravis (MG) is an immune mediated, post-synaptic neuromuscular transmission disorder, presenting with predominant ocular, bulbar, and/or proximal fluctuating weakness and fatiguability. Distal and asymmetric onset of symptoms in MG is rare and could lead to delay in diagnosis especially when fatiguability or fluctuation is not clearly reported as a prominent initial symptom – as seen with our patients. We report three cases of distal MG who presented with predominant distal, asymmetric hand weakness. Their clinically diagnoses for referral to the electrodiagnostic (EDx) laboratory were: Chronic inflammatory demyelinating peripheral neuropathy, C8T1 motor radiculopathy, and multifocal motor neuropathy. It was in the EDx laboratory that the diagnosis of MG was suspected in these patients. Since the routine EDx tests were normal in all three patients – A repetitive nerve stimulation test (RNST) was done – which was positive in the affected muscles and hence a diagnosis of distal MG made. (This is the protocol followed in our laboratory) These patients were then found to have high serum levels of antibodies to acetyl choline receptors – confirming the diagnosis of MG. RNST is not routinely done in all patients sent for EDx testing and none of these patients had a reference for the same – however, using a protocol based method of EDx testing, lead to the diagnosis of a treatable condition. Electrodiagnostician need to be aware of this presentation of MG and follow protocols or the diagnosis could be missed.","PeriodicalId":85654,"journal":{"name":"The Bombay Hospital journal","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90315828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cushing's Syndrome: Don't let A Pituitary Adenoma Fool You!","authors":"P. Thakkar, Foram Sanghavi, Suneel Shah","doi":"10.15713/ins.bhj.23","DOIUrl":"https://doi.org/10.15713/ins.bhj.23","url":null,"abstract":"We present the case of a young male admitted with Cushing's syndrome and a pituitary microadenoma for trans-sphenoidal surgery. An equivocal ACTH level and incomplete work up for the hypercortisolism prompted postponement of the surgery in favour of further investigation which revealed an adrenal adenoma. He finally underwent a laparoscopic left adrenalectomy which proved curative. Bombay Hospital Journal, Vol. 62, No. 1, 2020 70","PeriodicalId":85654,"journal":{"name":"The Bombay Hospital journal","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82811178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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